Particle therapy using protons or carbon ions for cancer patients with cardiac implantable electronic devices (CIED): a retrospective multi-institutional study

Purpose To evaluate the outcomes of particle therapy in cancer patients with cardiac implantable electronic devices (CIEDs). Materials and methods From April 2001 to March 2013, 19,585 patients were treated with proton beam therapy (PBT) or carbon ion therapy (CIT) at 8 institutions. Of these, 69 patients (0.4%, PBT 46, CIT 22, and PBT + CIT 1) with CIEDs (64 pacemakers, 4 implantable cardioverter defibrillators, and 1 with a cardiac resynchronization therapy defibrillator) were retrospectively reviewed. All the patients with CIEDs in this study were treated with the passive scattering type of particle beam therapy. Results Six (13%) of the 47 PBT patients, and none of the 23 CIT patients experienced CIED malfunctions (p = 0.105). Electrical resets (7) and over-sensing (3) occurred transiently in 6 patients. The distance between the edge of the irradiation field and the CIED was not associated with the incidence of malfunctions in 20 patients with lung cancer. A larger field size had a higher event rate but the test to evaluate trends as not statistically significant (p = 0.196). Conclusion Differences in the frequency of occurrence of device malfunctions for patients treated with PBT and patients treated with CIT did not reach statistical significance. The present study can be regarded as a benchmark study about the incidence of malfunctioning of CIED in passive scattering particle beam therapy and can be used as a reference for active scanning particle beam therapy.

A Critical Review of Radiation Therapy: From Particle Beam Therapy (Proton, Carbon, and BNCT) to Beyond

In this paper, we discuss the role of particle therapy—a novel radiation therapy (RT) that has shown rapid progress and widespread use in recent years—in multidisciplinary treatment. Three types of particle therapies are currently used for cancer treatment: proton beam therapy (PBT), carbon-ion beam therapy (CIBT), and boron neutron capture therapy (BNCT). PBT and CIBT have been reported to have excellent therapeutic results owing to the physical characteristics of their Bragg peaks. Variable drug therapies, such as chemotherapy, hormone therapy, and immunotherapy, are combined in various treatment strategies, and treatment effects have been improved. BNCT has a high dose concentration for cancer in terms of nuclear reactions with boron. BNCT is a next-generation RT that can achieve cancer cell-selective therapeutic effects, and its effectiveness strongly depends on the selective 10B accumulation in cancer cells by concomitant boron preparation. Therefore, drug delivery research, including nanoparticles, is highly desirable. In this review, we introduce both clinical and basic aspects of particle beam therapy from the perspective of multidisciplinary treatment, which is expected to expand further in the future.

Two cases of severe esophageal ulcer caused by chemotherapy for breast cancer after particle beam therapy for esophageal cancer

Background: Particle beam treatment for esophageal cancer can produce a better local therapeutic effect than can conventional radiotherapy. However, events that occur in the esophagus during or after the treatment of other cancers after that are unknown. Case summary: The first patient, a 64-year-old woman, had undergone heavy ion radiotherapy for esophageal cancer. Endoscopic submucosal dissection was performed for local residual tumor. Five years later, cancer was found in the right breast, and the patient underwent partial mastectomy and adjuvant chemotherapy. Six years after heavy ion radiotherapy, oral intake became difficult. A benign esophageal ulcer with circumferential stenosis was observed at the site of heavy particle irradiation. The second patient, a 63-year-old woman, had undergone proton therapy for esophageal cancer and photodynamic therapy for local residual tumor. Four years later, cancer was found in the left breast, and the patient underwent preoperative adjuvant chemotherapy, which reduced the size of the breast cancer. Oral intake became difficult 5 years after proton therapy. Endoscopy showed a benign esophageal ulcer with severe stenosis at the site of proton irradiation. Conclusion: After particle beam therapy for esophageal cancer, patients who undergo chemotherapy for other cancers may develop an esophageal ulcer. Keywords: Particle beam therapy; esophageal cancer; esophageal ulcer; breast cancer; chemotherapy

Recent advances in understanding and managing chordomas: an update

Chordomas are rare and difficult-to-treat tumors arising from the embryonic notochord. While surgery is the mainstay of treatment, and despite new techniques aimed at maximizing total tumoral resection, recurrence remains high and the probability of disease-free survival low. New breakthroughs in genetics, targeted molecular therapy, and heavy-particle beam therapy offer some promise as adjuvant treatments in addition to surgical resection. A multidisciplinary approach encompassing genetics, immunotherapy, radiation therapy, and surgery, at a facility experienced in the management of this complex disease, offers the best chance of survival and quality of life to patients while limiting the intrinsic morbidity of these treatments.